What are Hemorrhoids (Haemorrhoids)?

Hemorrhoids (haemorrhoids), also known as piles, are lumps or swollen veins that occur in the anal passage. While some people with hemorrhoids are asymptomatic, others may experience symptoms, such as bleeding and pain. In Australia, up to 40% of people will have hemorrhoids [1].

Internal Hemorrhoids vs External Hemorrhoids

There are two main types of hemorrhoids - external and internal. Internal hemorrhoids tend to occur inside the rectum and are usually painless. In comparison, external hemorrhoids occur outside the rectum along the skin of the anus. Compared to internal hemorrhoids, they are generally more painful.

Thrombosed hemorrhoids

Thrombosed hemorrhoids are clot(s) that usually form inside external hemorrhoids. The clot forms because of bleeding from veins found inside the anus [2]. These clots can develop due to sudden body pressure, such as heavy lifting or coughing. These thrombosed hemorrhoids can be painful but can be effectively treated by consulting a GP.
 

Hemorrhoids Symptoms - What do Hemorrhoids feel like?

Hemorrhoid symptoms may vary depending on the type and severity of the condition. These general symptoms will be noted below and then separated into four classifications depending on their severity [2].

Rectal and/or anal pain

Bleeding from the rectum after emptying your bowels

Itchy anus

Bumpy protrusions around the anus

Feeling that you haven’t emptied your bowels after emptying your bowels

Stage 1 Hemorrhoids

Bright red bleeding while emptying your bowels but no significant pain.

Stage 2 Hemorrhoids

Bright red bleeding during the emptying of your bowels with obvious bumps around the anus. After finishing, these bumps will return to normal.

Stage 3 Hemorrhoids

Bleeding occurs during the emptying of bowels with noticeable and larger bumps around the anus. After finishing, you may need to assist with flattening the bumps manually. These may be more painful during excretion.

Stage 4 Hemorrhoids

Also known as prolapsed hemorrhoids, stage 4 is the most severe. Bleeding and mucus may leak around the anus while emptying bowels. Additionally, bumps will be prolapsed and will not be able to be flattened. They can be quite painful.
 

What causes Hemorrhoids?

Causes of hemorrhoids will depend on your own set of circumstances. One of the most frequent causes includes having a hard stool, particularly with constipation. Hemorrhoids can occur due to the pressure onto the anal and rectal veins due to the harder stools. Other causes can also include [4]:

Insufficient fibre in your diet

Ageing

Spending more time than you need in the toilet

Pushing too hard

Lifting heavy weights

Wiping too hard

Pregnancy

Are Hemorrhoids Contagious?

Hemorrhoids are not contagious. However, sharing the same low fibre diet within the same household can lead to hemorrhoids.
 

Hemorrhoids Tests and Diagnosis

Hemorrhoids can be diagnosed through comprehensive medical questioning and a physical examination by a GP. Signs that GPs may observe are the presence of pain, lumps and bleeding around the anus. The GP may need to see and use their hands to inspect the region during a physical examination. Usually, only external hemorrhoids can be detected. However, there may be situations where GPs may opt for further tests.

Colonoscopy

A GP may also recommend a colonoscopy to rule out the possibility of other conditions, such as colon polyps and/or cancer. Especially if you have a family history of colorectal problems and middle age, you are more likely to develop more serious conditions. For more information about colonoscopy, please click our link here.

Hemorrhoids Treatment - How to Get Rid of Hemorrhoids

Most hemorrhoid treatments can be managed without surgery. Instead, medications and lifestyle changes can reduce hemorrhoids. GPs will recommend treatments depending on the severity of the condition, and the symptoms felt.

Hemorrhoids Self-Care

The first line of treatment (particularly for mild to moderately severe hemorrhoids) is self-care. Changing daily lifestyle habits can help reduce symptoms. Examples of these lifestyle habits include:

Eating a more high-fibre diet (e.g. vegetables, fruit, whole grains, beans, etc.)

Reducing unnecessary time spent on the toilet

Don’t try to push too hard on the toilet.

Do not hold in the urge to empty your bowels

Avoid wiping too hard.

Visiting your GP if you’re constipated. Adjustments may be made to medications that cause constipation, such as codeine. Additionally, GPs may also recommend laxatives to help with excretion.

Hemorrhoid Pain Relief

Your GP may also prescribe medications if your hemorrhoids are causing you pain. Over the counter topical hemorrhoid creams, ointments and suppositories can be used to manage pain. These medications are applied on the skin, which contains ingredients, such as local anaesthetics, which help reduce pain and itching [2]. In some situations, GPs may also prescribe a corticosteroid cream to reduce long term inflammation. Please only use as directed by your doctor as long-term use can lead to thinning of the skin.

Other treatments

In some circumstances, other treatments may be required for hemorrhoid management and to reduce symptoms. These include:

Sclerotherapy injections

This is a viable treatment for those not noticing improvement with first-line treatment and possess grade 1 or 2 hemorrhoids. Using a short-tubed device called a proctoscope, a medicated solution is injected into the hemorrhoids. These injections aim to disrupt the blood supply of hemorrhoids, which causes them to shrink.

Rubber band ligation

Rubber band ligation is generally indicated for those with grade 2 or less severe grade 3 hemorrhoids. Using a proctoscope, a rubber band is placed around the base of the hemorrhoid(s). Similar to sclerotherapy, the aim is to reduce blood flow and to allow it to fall off to be passed through.

Stapling

Those with stage 3 hemorrhoids may require stapling, which is a newer form of treatment. After removing some hemorrhoid tissue, it is stapled back to the rest of the rectal.

Hemorrhoid surgery

There may be circumstances where your GP may refer you to a specialist and recommend surgery. Hemorrhoidectomy can be performed under general anaesthetic for hemorrhoid removal with a scalpel or laser.
 

Hemorrhoid Recovery

The duration of symptoms will depend on the severity, size and location of your symptoms. Most hemorrhoids can be successfully managed with just home remedies and strategies from their GP.

How Long Do Hemorrhoids Last?

For most people, hemorrhoids will resolve within 1-2 weeks after seeing their GP. However, this will vary from person to person.
 

Complications

There are several complications of hemorrhoids if they are not appropriately managed or left untreated. Examples can include [2]:

Chronic hemorrhoids where symptoms can last for months

Rectal prolapse occurs when the rectal tissue turns inside and out.

Excessive bleeding.

Strangulated hemorrhoids can lead to increased rectal/anal pain due to the blood supply being cut off.

Blood clots can occur due to the bleeding from a hemorrhoid.
 
 

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  References

1. Kibret, A. A., Oumer, M., & Moges, A. M. (2021). Prevalence and associated factors of hemorrhoids among adult patients visiting the surgical outpatient department in the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Plos one, 16(4), e0249736.
2. https://www.racgp.org.au/download/documents/AFP/2010/June/201006daniel.pdf
3. https://www.racgp.org.au/afpbackissues/2003/200307/20030705orlay.pdf
4. https://www.niddk.nih.gov/health-information/digestive-diseases/hemorrhoids/symptoms-causes